H Health
Dr Rod Pearce
Never let those arteries harden S
ome words in medicine give a clue as to what a doctor might be describing. If a name ends in “itis”, the diagnosis is probably an infection, swelling such as tonsillitis, or an appendicitis. Sclerosis, on the other hand, refers to a hardening of tissue, or scarring or thickening. Multiple sclerosis is the hardening and scarring of nerves and nervous tissue. Arterial hardening refers to thickening or scarring of the arteries (arteriosclerosis). Through arteries, the heart distributes blood throughout the body. So, any hardening of the arteries will affect the ability of the heart to get adequate blood (with oxygen and nutrition) to any part of the body. A poor blood supply to the brain, the heart or the legs can lead to a stroke, a heart attack or gangrene and amputation respectively. If the arteries are damaged all around the body, the condition is said to be an “arterio-path”. This condition is commonly in people who smoke. The hardening is usually divided into three types: • The inner layer of the artery – damaged by the build-up of cholesterol. This is “atherosclerosis” but, because it is the most common form of artery hardening, the terms arteriosclerosis and atherosclerosis are frequently used interchangeably. • The middle layer – hardening involves the destruction of muscle and elastic fibres and the formation of calcium deposits. This makes it possible to estimate artery damage
by seeing calcium on X-rays or CT scans. • The smaller arteries (arterioles) – arteriolar sclerosis. All three forms might be present in the same patient, but in different blood vessels. A doctor working at preventing someone from having a heart attack usually thinks of any and every disease which might stop hardening of the arteries to the heart. By preventing that hardening, the rest of the body is usually protected. Smoking was years ago identified as the worst thing that could happen to arteries. It speeds up the natural hardening. And other diseases make that situation worse. If you have high blood pressure, the arteries will crack more often, repair badly if you smoke, harden quicker, and lead to an early heart attack. Every time the arteries are damaged, cholesterol will build up on the inside of the arteries quicker and make a heart attack worse – if you already suffer high cholesterol. And, if you have diabetes, the high sugar makes all that worse. It is a bit like worrying about your car rusting. The worst thing you could do is to leave it outside, uncovered, on the sand, by the sea. If you have high cholesterol, diabetes and hypertension, you are in trouble. And, if you smoke, the problems are multiplied. We know that cholesterol mends arteries and keeps them soft and pliable. We know that good cholesterol maintains the arteries in good shape
So, any hardening of the arteries will affect the ability of the heart to get adequate blood (with oxygen and nutrition) to any part of the body.
and can even reverse damage (after, say, a heart attack) if there is a higher proportion of good compared to bad cholesterol. To estimate your risk of cholesterol damage (hardening of the arteries), the usual tests are of total cholesterol (TC) and the amounts of good cholesterol (HDL) and bad cholesterol (LDL). Diabetes and raised glucose also predict early hardening. Hypertension remains a lethal problem, essentially increasing the risk of a blood vessel (artery) rupture and bleed just from the pressure effect. If someone has a stroke because of arteriosclerosis, it is assumed there is a parallel risk of heart attack and kidney disease. With smoking and diabetes, the amputation of gangrenous toes, feet and limbs is the visible sign of hardening of the arteries. With oxygen unable to get to the distal limbs and digits, gangrenous material has to be removed to stop infection and death. This is known as peripheral vascular disease (PVD). Just as PVD affects the legs (in men) it is likely to affect the penis through erectile dysfunction. A group of diseases which cause hardening and tightening of skin and connective tissues (scleroderma) is thought to be an immune system abnormality. It causes collagen build-up in the blood vessels (arteriolar sclerosis) causing further damage to tissue.
Continued page 40 February 2020
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